Editorial: Too soon for CCO-type expansion

Long before we know if Oregon’s experimental Coordinated Care Organizations will succeed, the state is touting them as the future of medical care for everyone.

What’s the point of an experiment if we move forward without waiting for the evidence? It’s time to slow down.

Coordinated Care Organizations, known as CCOs, seek to improve care while bending the cost curve. As Bulletin reporter Lily Raff McCaulou detailed in her Friday-through-Sunday series, the federal government agreed in 2011 to give Oregon nearly $2 billion over five years to implement the effort. In return, Oregon promised to slow the growth of spending by 2 percent in its Medicaid program, known as the Oregon Health Plan.

It’s a complex system and some details are still evolving, but it depends on adding flexibility in how health care dollars are spent, providing care before a patient is in crisis, and changing the incentives for health care providers.

Some of those ideas are obvious common sense. Preventing expensive hospitalizations by providing timely care is a no-brainer. If the needed “care” is an air conditioner for a heart patient, then so be it. Another good one: requiring coordination among a patient’s various providers.

But the benefits of other provisions are not so clear.

Most troubling is the issue of changing incentives.

One oft-heard complaint about the existing U.S. system is that our fee-for-service payment method encourages doctors to provide unnecessary tests and treatments. The system of CCOs turns that around, paying a lump sum for each patient no matter what services are provided. In other words, the provider earns more by providing less care.

Remember the horrors of early HMOs?

The experiment tries to address that problem by judging providers according to quality measures, including patient satisfaction, and adjusting their compensation accordingly.

Nobody knows if this will work, and if it doesn’t, the results will be critical.

Nevertheless, the state is moving forward to extend the number of people affected. Recent announcements revealed that some CCO-type provisions are being added to state workers’ medical coverage. Gov. John Kitzhaber has said the CCO approach will spread to private insurance.